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PHM BSc - Trauma Science > Neurotrauma > Flashcards

Neurotrauma Flashcards

1
Q

Breathing patterns associated with damage to

a) cerebrum
b) pons
c) medulla

A

a) Cheyne stokes (alternating hyperpneoa and apnoea)
b) apneustic (prolonged pause at end inspiration)
c) ataxic (irregular in rate and volume)

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2
Q

How is the size of an intracerebral haematoma calculated

A

(a x b x c) / 2
a=maximum haematoma diameter
b=haematoma diameter at 90 degrees to a
c=number of CT slides with haematoma visible x slice thickness

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3
Q

How is CPP calculated

A

MAP - ICP

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4
Q

How is MAP calculated

A

2/3 diastole + 1/3 systole

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5
Q

In which patients should ICP be monitored

A

GCS 3-8 with abnormal CT

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6
Q

How is RICP managed?

A 
ventilate and oxygenate
keep CO2 at the low end of normal (4)
nurse at 30 degree angle
mannitol 100ml 20%
paralyse (to reduce cerebral O2 requirements)
normoglycaemia 
phenytoin for seizures
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7
Q

What are the advantages and disadvantages of paralysing a patient in RICP management?

A

reduces cerebral O2 requirements
allows TTM
can’t assess any progress

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8
Q

Define mild, moderate and severe TBI according to GCS

A

mild: 14-15
mod: 9-13
severe: <9

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9
Q

What is a primary head injury

A

Injury occurring at the time of the impact. Can be vascular, neuronal, axonal

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10
Q

What is a secondary head injury

A

processes occurring later down the line that has been triggered by the primary head injury

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11
Q

State some examples of processes that can occur as part of a secondary head injury

A 
ischaemia
hypoxia
neuroinflammation (cytokines and chemokines)
RICP
infection
seizures
mitochondrial dysfunction
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12
Q

What is a tertiary/late secondary head injury

A

injury occurring years after the primary injury. Thought to be due to proteinopathies. Patients can present with MND, Parkinsons, alzheimers, fronto-temporal dementia

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13
Q

What are some faults with GCS

A

skewed important to motor
can’t assess if facial/ocular injury
can’t assess if intubated
designed for purely head injured patients

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14
Q

Talk through the eye component of GCS

A

4: spontaneous eye opening
3: open to verbal command
2: open to pain
1: no response

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15
Q

Talk through the verbal component of GCS

A

5: orientated
4: confused
3: inappropriate words
2: incomprehensible sounds
1: no response

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16
Q

Talk through the motor component of GCS

A

6: spontaneous movements
5: localise pain
4: withdraw from pain
3: flexion (decorticate)
2: extension (decerebrate)
1: no response

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17
Q

What should you examine in a possible head injury patient

A 
breathing pattern
pupils 
ocular movements (cranial nerves)
c-spine 
auscultate the carotids
limb movements and power
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18
Q

Indications for a CT after a head injury

A 
GCS <13
GCS <15 after 2 hours
>1 episode of vomiting
open, depressed or basal skull fracture
seizure
focal deficit
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19
Q

Compare the appearance of a T1 and T2 weighted MRI

A

T1: black CSF. Grey matter is grey and white matter is white
T2: bright CSF. Grey matter is white and white matter is grey

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20
Q

What does acute and hyperacute blood look like on a CT

A

acute is hyperdense (bright)

hyperacute can appear as a darker patch within the bright acute bleed

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21
Q

What motion often causes DAI

A

rotational

acceleration/deceleration

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22
Q

What is the pathophysiology of DAI

A

sheering of G/W matter interface

wallerian degeneration distal to the sheering forces

23
Q

What is the CT appearance of DAI

A

homogenous loss of G/W matter interface

scattered punctae

24
Q

What is a cerebral contussion

A

microhaemorrhages and small vessel leaks

They are <1cm

25
where are contussions most likely to occur
inferior frontal temporal poles these are both sharp and ridgy areas
26
State some clinical features suggestive of a basal skull fracture
``` racoon eyes battles sign CSF rhinorrhoea and ottorhoea haemotympanum CN signs ```
27
Where is a basal skull fracture most likely to occur
longitudinal fracture of the petrous part of the temporal bone
28
what is a concussion
temporary alteration of consciousness no structural damage absence of a penetrating injury
29
compare the bleeding source associated with extradural vs subdural vs subarachnoid haematomas
extra: middle meningeal artery or DVS subdural: cortical bridging veins subarachnoid: berry anneurysm, AV malformation
30
what is the likely source of bleeding in a posterior fossa bleed
DVS
31
where does the middle meningeal artery originate and which foramen does it travel through
``` maxillary artery (branch of ECA) foramen spinosum ```
32
describe the clinical presentation of extradural, subdural and subarachnoid haemorrhages
extra: lucid interval subdural: presents like an evolving stroke subarachnoid: occipital thunderclap headache
33
Describe the CT of an extradural haematoma
lenticuloform | limited by suture lines
34
describe the CT of a subdural haematoma
crescent not limited by suture lines can enter sulci loss of G/W matter interface
35
describe the CT of a subarachnoid haematoma
hyperdense basal cisterns and sulci
36
What 2 mechanisms lead to ischaemia in secondary brain injury
blood is an irritant so get vasospasm | RICP leads to reduced CPP
37
how does cerebral oedema occur in secondary brain injury
extracellular to intracellular because of NaK pump failure | intravascular to interstitial because of BBB breakdown
38
Describe the Monro-Kellie hypothesis
Pressure-volume relationship aiming to keep a dynamic equilibrium among non-compressible components in a rigid skull. Components within the fixed rigid skull will compensate for an increased intracranial volume up until a point at which ICP begins to rise
39
What are the x and y axis on the monro-kellie graph
x: intracranial volume y: ICP
40
Describe cushings reflex
Hypertension: brainstem compression stimulates sympathetics to try and overcome the ICP and maintain CPP Bradycardia: in response to the hypertension the carotid sinus stimulates a vagal response reduced RR: ischaemia of the respiratory centers in the brainstem
41
State the types of herniation syndrome
subfalcine uncul tonsillar
42
what is compressed in a subfalcine herniation and what does this result in clinically
the cingulate gyrus is compressed under the falx cerebri | ACA compressed leading to contralateral leg weakness
43
what is compressed in a uncal herniation and what does this result in clinically
uncus of the temporal lobe CN3: ipsilateral dilated, down and out pupil CN6: diplopia reticular formation: reduced GCS cerebellar peduncle: contralateral hemiparesis
44
Describe kernohans phenomenon
contra-lateral cerebellar peduncle compressed where the descending motor tracts are located giving ipsilateral (to the lesion) motor weakness
45
what is compressed in a tonsillar herniation and what does this result in clinically
cerebellar tonsils compressed through the foramen magnum | cardioresp centres in medulla compressed
46
How can ICP be measured
ICP bolt intraventricular catheter intraparenchymal pressure monitor
47
Define secondary brain injury
progressive series of complex, interconnected, biochemical events all ending in neuronal death
48
craniotomy vs craniectomy
craniotomy: bone is replaced craniectomy: bone is left off and the skin flap closed
49
what are mayfield pins
hold the head in place whilst a craniectomy/otomy is performed
50
why do burr holes tend not to work in haematoma management
because the blood is thick and clotted
51
which type of haematoma might a burr hole work and why
chronic subdural when the blood has gone back to a liquid
52
what is secondary impact syndrome
seen in younger patients | following a concussion there is malignant oedema
53
anterograde vs retrograde amnesia
anterograde: can't form new memories retrograde: inability to recall past memories
54
when should a neurosurgeon become involved in head injury patients
``` GCS <8 or deteriorating Confusion >4 hours progressive focal neurological signs seizure without full recovery depresed skull fracture penetrating injury CSF leakage ```

PHM BSc - Trauma Science (15 decks)

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